Finding the right balance: Medicare Compliance Audits.

The Commonwealth Government has recently released an exposure draft for the proposed Health Insurance (Compliance) Bill, after a decision in the 2008-9 Budget to increase Medicare compliance audits.The Bill expands Medicare Australia’s powers in relation to compliance audits under the Medicare scheme. It allows the CEO of Medicare Australia to give a notice to health practitioners to produce documents, which could include the health care records of patients, to substantiate a Medicare benefit payed in respect of a service.PIAC recognises that the draft Bill raises two potentially competing public interest principles. The first is the public interest that Australian consumers have in the maintenance and integrity of Australia’s universal health scheme, Medicare.On the other hand, there is a distinct public interest principle in the confidentiality of the medical and health records of patients.PIAC concludes that the Bill, together with the privacy safeguards already in place for Medicare Australia, appropriately balances the public interest in the integrity of Medicare and the public interest in the maintenance of patient confidentiality and privacy of health records.PIAC notes that the draft Bill will be subject to a Privacy Impact Assessment by the Commonwealth Privacy Commissioner. PIAC supports the principle that patients should be advised, wherever practicable, when their records are accessed for audit purposes. PIAC, however does not support the proposition that an individual’s consent be required before individuals’ records are assessed for audit purposes